	<div class="modal-header">
    	<a class="close" data-dismiss="modal">&times;</a>
    	<h3>虚假信息举报</h3>
    </div>
    
<form name="form" action="/ajax/dojubao" method="post" enctype="multipart/form-data" >
    <div class="modal-body">
       
    
            <dl class="dl-horizontal">
                <dt>举报理由</dt>
                <dd>
                    <select name="j_type">
                        <option value="0">请选择举报原因</option>  
                        <option value="1">价格虚假</option>
                        <option value="2">车源信息虚假</option>
                        <option value="3">车辆已售出</option>
                        <option value="4">电话打不通</option>
                    </select>
                </dd>
                
                <dt>问题描述</dt>
                <dd>
                    <textarea name="j_content" id="" cols="30" rows="5"></textarea>
                </dd>
                <dt>联系方式</dt>
                <dd>
                    <input type="text" value="" name="j_contact_tel" />
                </dd>
                <dd>留下您的联系方式，方便客服与您联系核实相关情况。</dd>
            </dl>
				<input type="hidden" value="" name="j_cid" />
    </div>
    
    <div class="modal-footer">
        <bottom class="btn btn-success" type="submit">确定</bottom>
    	<a href="#" data-dismiss="modal" class="btn">取消</a>
	</div>
</form>